Provider Demographics
NPI:1396095683
Name:KALDAHL, CHELSEA (LMT)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:KALDAHL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 NORKENZIE RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1958
Mailing Address - Country:US
Mailing Address - Phone:541-954-7993
Mailing Address - Fax:
Practice Address - Street 1:1708 NORKENZIE RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1958
Practice Address - Country:US
Practice Address - Phone:541-954-7993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17819225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist